JURIED POSTER ABSTRACT PROGRAM - USIMiranda Wahnsiedler MSN, BS, AGCNS-BC. RNC-OB, and Linda Baxter,...

JURIED POSTER

ABSTRACT PROGRAM

22nd Annual Nursing and Health Professions Research Conference

Research, Evidence-Based Practice, and Performance Improvement in Healthcare Conference

Wednesday, April 18, 2018

University of Southern Indiana

College of Nursing & Health Professions

A New Twist on Nitrous Oxide in Labor and Delivery

Miranda Wahnsiedler MSN, BS, AGCNS-BC. RNC-OB, and

Linda Baxter, BSN, RNC-OB

St. Vincent

Introduction/ Background: Nitrous Oxide use in the US has been on the rise over the last five years for analgesia during all stages of labor, as well as during post delivery procedures as it provides patients more mobility and control options.

Statement of the Problem: At this level 3 obstetrical care facility, for the approximate 5-15% of patients that are admitted for labor that either cannot or do not want to have regional anesthesia with an epidural, the only other pharmacological option is intravenous Nubain or Stadol, which can be sedating to the mother and the fetus and increase the need for resuscitation in the newborn if administered near the time of delivery.

Methods: An A3 performance improvement was developed utilizing a fishbone diagram to identify reasons why a mother would not want or could not have regional anesthetic.

Processes Addressed: A review of the literature and pricing information was presented for approval and to the OB physicians, anesthesiologists, and hospital Value Analysis Team by the CNS. Interdisciplinary meetings with the respiratory therapy established processes for proper gas ordering, storage, and handling. Staff training including a hospital policy and patient consent was developed and co-presented by the CNS and company representative for the RNs to set up and manage the Nitronox system with a physician order. Changes were made in the documentation system to allow for appropriate documentation. The new intervention went live on February 8, 2017.

Outcomes: Data collection resulted in a total of 46 patients utilizing Nitrous Oxide. Patients were surveyed on their satisfaction of the intervention. Patients rated satisfaction in anxiety management higher than for pain management, with an overall satisfaction rate of 77.4%. Over 90% of patients would recommend Nitrous Oxide to other laboring women.

Implications for Practice: The use of Nitrous Oxide can be used as an effective intervention for pain and anxiety

management for laboring women.

A Tough Tube to Swallow: NG Tube Insertion using Atomized Lidocaine

Abby Schmitt, MSN, RN-BC, Michele Messmann, BSN, RN, Cindy Starling,

MSN, RN, CCRN-K, Kate Willegal, DNP, RN, Kelsey Kunkel, MSN, RNC-OB,

Rebecca Strange, MSN, RN, PCCN, and Jessica Opel

Memorial Hospital and Health Care Center

Background / Significance of Problem:

Bedside nasogastric tube insertion is known to cause discomfort for patients. Studies reflect benefit with using nasal anesthetic. Recommendations are offered to decrease procedural discomfort, yet clinical updates are not predominant in nursing clinical practice. Foremost, the personal experience of a patient was a large driver for best practice review.

Clinical Question:

For hospitalized patients requiring insertion of nasogastric tubes, can nasal atomized lidocaine pre-procedure be beneficial compared to traditional insertion with no anesthetic?

Search of Literature/ Best Evidence:

Databases used included CINAHL Complete, Nursing Reference Center Plus, and UpToDate. Search words comprised of nasogastric tube, insertion, anesthetic, and lidocaine yielded 23 articles. Of those retrieved, 12 articles met inclusion criteria.

Clinical Appraisal of Literature / Best Evidence:

Overall discomfort of bedside nasogastric tube insertion was found to be lessened with use of an anesthetic, through anecdotal staff reports and patient perceptions. Recommendations favor anesthetic utilization for patient comfort. Literature reflects need for further studies to detail guidelines on anesthetic type and dosage. Gel, atomized, and nebulized lidocaine were most reviewed

Integration into Practice:

Collaboration with key stakeholders included nursing shared governance, pharmacy and therapeutics leaders, value analysis members, and licensed independent providers. Initial approval included lidocaine gel, but was reformed to 4% lidocaine atomized nasally due to practicality and administration ease. The nursing protocol promotes safety and optimal outcomes for this population. When the provider orders a nasogastric tube, an automatic protocol is initiated for the nurse. Atomized lidocaine is sprayed into the selected nostril, dwells for 5 minutes, and lastly the tube is inserted with sterile jelly lubrication.

Evaluation of Evidence-Based Practice:

The atomized technique has been piloted in the emergency department, where over half of the organization’s nasogastric tubes are inserted. Full implementation of the protocol is in process; inpatient nurses are amidst education. After implementation, procedure evaluation and refinement will occur. A patient and staff survey is being reviewed to obtain post-placement perceptions and anecdotal reports.

Does Caffeine Intake in Children and Adolescents Pose a Higher Risk for Anxiety

and/ or Depression?

Karen Bevers, Sabrina Reno, Olivia Kelley, and Kim Sanders


Background / Significance of Problem: According to The Academy of Pediatrics and the American Psychological Association, caffeine

intake in children and adolescents is on the rise and has been linked to neurological harmful

effects. As the increase in caffeine consumption in children and adolescents rises, it is probable

that a greater percentage of youth will have harmful neurological effects, such as anxiety and/or

depression.

Clinical Question: Are children and adolescents ages 7 to 17 who consume caffeine at higher risk for anxiety

and/or depression compared with no caffeine intake? This etiology question is used to assess

anxiety and/or depression in children and adolescents who consume caffeine.


A literature review was completed using PubMed, Proquest, and Sage Journals using several

search terms such as caffeine intake, caffeine, caffeine consumption, children, adolescents,

depression, anxiety, emotional disorders, mood, and nutrition. Included were articles published

between years 2007- 2017. Of 17 articles collected, 4 primary articles met inclusion criteria and

were analyzed using the Guidelines of The Academy of Nutrition and Dietetics.

Clinical Appraisal of Literature/ Best Evidence: Although strong studies exist that show a correlation between caffeine consumption and

greater anxiety and depression among children and adolescents, the general research design

flaws do not allow definitive conclusions about caffeine intake. However, it appears that children

should avoid caffeine intake due to both short term anxiety and depression.

Integration into Practice: Children that have anxiety and/or depression should limit caffeine intake.

Evaluation of Evidence- Based Practice: Based on the criteria of the Academy of Nutrition and Dietetics a Grade II: Fair is given: the

evidence consists solely of results from strong designs that have research designs flaws and issues

of generalizability.

Folate and Autism: Is There a Cause for Concern?

Jennifer Moore-Thomas, Alexis Brewer, Jessica Lincoln, and Juan Martinez


Introduction / Background:

Folate helps aid in preventing many birth defects, including neurological complications. However, there is concern that the growing cases of autism in children are linked to the consumption of too much folate as it is recommended for prenatal care and found in all prenatal care vitamins.

Clinical Question:

For children (age 1-17 years of age), does a mother’s use of folate supplements during

pregnancy increase their risk of developing autism compared to no folate

supplementation.

Search of Literature / Best Evidence:

A literature review was completed using MEDLINE, ProQuest, PubMed, and CINAHL databases using search terms such as Autism Spectrum Disorders, folate, pregnancy, prenatal vitamins, folic acid, child, mothers, prenatal care, offspring, and clinical diagnosis. Included articles were between 1995 – 2017. Of 110 articles collected, eight met inclusion criteria, four being primary and four review.


Currently, research of sufficient design is limited. Of the research conducted, it has been concluded that folate intake during pregnancy can reduce the risk of autism diagnosis in children.


The AND position on folate supplementation is that “All women, including adolescents, who are capable of becoming pregnant should consume 400 mg/day folic acid from fortified foods and/or dietary supplements, in addition to eating food sources of folate. Pregnant women are advised to consume 600 mg dietary folate equivalents daily from all food sources.” As the cause of autism is unknown, investigation on the effect of folate supplementation is warranted.

Evaluation of Evidenced-Based Practice:

Based on the criteria of the American Academy of Nutrition and Dietetics a Grade II: Fair is given. Evidence consists of results from studies of strong design, but there is uncertainty attached to the conclusion because of inconsistencies among the results and doubts about generalizability, bias, research design flaws or adequacy of sample size. Some evidence consists of results from weaker designs, but results are confirmed in separate studies and consistent with minor exceptions at most.

Improving Patient Outcomes with Nursing Specialty Certification

Nellie Jones, RN, CMRSN

Memorial Hospital and Health Center, Jasper Indiana

Background / Significance of Problem: The Affordable Care Act (ACA) changed the way that hospitals are reimbursed by Medicare. The changes enacted by the passage of the ACA tied these reimbursements to outcomes and costs associated with certain inpatient care programs. Organizations must prove they are providing quality care to the patients served. The National Database of Nursing Quality Indicators (NDNQI) measure nurse sensitive process and outcome measures. Organizations not meeting performance levels on certain outcome indicators were seeing already reduced reimbursement become less. Direct-care bedside nursing plays an integral role in patient care and outcomes. The education and clinical expertise is crucial in identifying early interventions for patients. Nursing specialty certification is a means for nurses to further education and show professional excellence.

Clinical Question: Does nursing specialty certification improve patient outcomes in acute care inpatient units?

Search of Literature / Best Evidence: A literature review was conducted using Elsevier, Google, CINAHL, and the National Institutes of Health databases combining the key words nurse specialty certification, patient outcomes, Medicare reimbursement, NDNQI, American Nurse Credentialing Center, and Academy of Medical-Surgical Nurses. Search criteria limited to articles published January 2013 through September 2017 which resulted in 14 articles.

Clinical Appraisal of Literature / Best Evidence: The articles selected showed improved patient outcomes with nursing specialty certifications. One study indicated improved Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) scores. Findings were consistent with improved patient outcomes of Ventilator Acquired Pneumonia (VAP), Catheter Acquired Urinary Tract Infections (CAUTI), and patient falls.

Integration into Practice: A pilot program has been developed to educate the direct-care bedside nurses on a 22-bed medical-surgical unit on the importance of nursing specialty certification and its relation to nursing excellence, improved patient outcomes, and Medicare reimbursement. The peer-to- peer education is being offered through unit meetings, educational handouts, and the hospital’s virtual journal club.

Evaluation of Evidence- Based Practice: A survey to evaluate the nurses’ knowledge, concerns, and barriers to nursing specialty certification will be administered at the conclusion of staff education program. A goal of five new specialty certified nurses by July 2018 has been set. Subsequently, a goal of two certifications per fiscal year has been determined until an 85% certification rate is achieved.

Nurse Residency Program Evaluation: The Development of Confidence for

New Registered Nurses

Amy M. Higdon, DNP(c), MSN, RN

University of Louisville School of Nursing

Background / Significance of Problem: Evaluation of a Nurse Residency Program (NRP) completed at an acute care facility in western Kentucky as a DNP scholarly project due to: 1) Student interest in opportunities to bridge the gap between education and practice 2) Best practices for NRPs were unknown by facilitators at organization..

Statement of the Problem: Ensuring new nurses receive the support they need when transitioning to professional nursing roles can increase competence and confidence. Research question: What components should be included in an NRP that can increase confidence and competence in new registered nurses?

Methods: Improvement-Focused Model guided NRP evaluation (Saewert, 2014)

Methods for program evaluation: • Observation of NRP sessions for two cohorts between August 2016 and April 2017 • Administration of Casey-Fink Graduate Nurse Experience Survey (2006) • Completion of face-to-face focus group session

Process Addressed: Project objectives: • 1. Identify best practices for NRPs • 2. Review current NRP curriculum for inclusion of best practices • 3. Obtain feedback from nurse residents about NRP experience • 4. Make recommendations for changes to NRP curriculum to reflect best practices

and consider feedback from nurse residents • 5. Provide plan for ongoing program evaluation

Outcomes: Descriptive statistics data analysis for Casey-Fink Graduate Nurse Experience Survey (2006) & thematic analysis for face-to-face focus group session

Survey results:

66.6% (n=10) of respondents strongly agreed staff was available during new situations/procedures & nurses provided support

Most difficult factor for new nurses transition was lack of confidence (n= 8 [53.3%])

Improved orientation would help new nurses feel more supported/integrated to unit (n= 7 [46.6%]).

Most satisfying aspect of work environment was peer support (n= 14 [93.3%)]

Focus Group Themes: • Interdisciplinary teamwork • NRP timing

• Simulation • Scheduling of NRP • Socialization •

Implications for Practice: • Implement changes to NRP to improve confidence levels for new nurses • Nurse administrators need to examine the relationship of confidence and nurse

retention • Prelicensure curricula should include activities that strengthen confidence levels for

future nurses

Optimal Bed Assignment Strategy Improves ED Throughput

Cara Wongngamnit, BSN, RN, and Anna Leslie, MSN, RN, NE-BC, CEN

Deaconess Hospital, Inc.

Backgrounds / Significance of Problem:

Factors adversely affecting timely bed assignment to appropriate care units included an

inefficient bed assignment workflow, poor communication between nursing and support

services, and no effective method for escalating resources when system bed needs reached

critical limits.

Statement of the Problem:

An opportunity existed to develop an efficient and expeditious Emergency Department (ED)

throughput without compromising patient safety or patient experience.

Methods:

A Lean Six Sigma methodology was used for the project.

Processes Addressed:

Nursing and business development leaders initially joined forces to identify options for

improving access for regional transfer patients. They soon identified the root cause was poor

patient throughput. An interprofessional team formed to study the intake process for patients

entering the two acute care hospitals. High variability in workflow from bed request in ED to

patient transport to the nursing unit was recognized. Out-of-the-box thinking resulted in the

formation of a central bed assignment center with a clinical nurse orchestrating system bed

management. By leveraging technology, standard workflow criteria was developed to assign

beds, activate system alerts and to facilitate conference call huddles on high demand days.

Development of unit action plans and standardized handoff communication between nurses and

support services allowed timely responses to high bed demands and decreased delays in ED

throughput..

Outcomes:

The process resulted in a statistically significant 18.2% decrease in average time from ED bed

order to arrival on nursing unit. Assignments meeting a 30 minute goal for clean beds improved

32% in 8-months. Also, an 18.5% growth in regional transfer admissions occurred. .

Implications for Practice:

Collaboration between nursing and support leaders is key to focusing practice strategies on

efficiencies without sacrificing patient-centered care. Quality processes built on standard work,

effective technology, and communication improved system bed assignments through

efficiencies to decrease ED admission delays.

Oral Hydration during Labor

Katie Pfaff, BSN, RNC

Memorial Hospital and Health Care Center Background / Significance of Problem:

It is common practice to restrict a laboring patient from eating and drinking. This restriction

may cause discomfort for the laboring mother and affect the labor process. Evidence shows

that oral hydration during labor does not cause harm. The American College of Obstetricians

and Gynecologists (ACOG) state oral intake in modest amounts of clear liquids may be allowed

for patients with uncomplicated labors.

Clinical Question:

Do laboring patients that receive oral hydration during labor have an increased risk for

aspiration or nausea?


Combining keywords labor, oral intake, hydration in labor, nausea, and complications in labor. A

Cochrane review, PubMed and Ball State CardCat multiple articles were identified, eight were

kept for the research of oral hydration during labor. These included: one committee, one

obstetric practice document, one practice guideline, one cochrane review of RCT and quasi RCTs

and one clinical bulletin.

Clinical Appraisal of Literature/ Best Evidence:

The literature review shows that oral hydration during labor is not shown to cause harm. ACOG

states oral intake in modest amounts of clear liquids may be allowed for patients with

uncomplicated labors. American Society of Anesthesia Guidelines for Anesthesia state laboring

patients with additional risk factors for aspiration (morbid obesity, diabetes mellitus, and

difficult airway) or patients with increased risk for operative delivery(non reassuring fetal heart

pattern) may have further restrictions of oral intake determined on case by case basis.


The oral hydration team presented to both Obstetrics and Anesthesia staff, going forward a

practice change will need to be made as well as policy change.


The oral hydration team has structured a plan to begin the oral hydration policy change after

both OB and anesthesia have agreed upon the policy change guidelines. The policy will then be

changed and practice change will be implemented.

Promoting Teamwork with “Helping Hands”

Abby Schmitt, MSN, RN-BC, Sam Spellmeyer, BSN, CMSRN, Abby Seifert,

BSN, CMSRN, Carrie Lueken, ASN, RN, Hilary Gutgsell, Nurse Intern,

Abby Recker, MSN, RN-BC, and Toni Eastridge, BSN, RN-BC

Memorial Hospital and Health Care Center Introduction / Background:

Communication between healthcare workers is critical to patient safety and a positive, productive work environment. The National Database of Nursing Quality Indicators (NDNQI) survey identified that nurses working on a medical-surgical unit expressed opportunity to

improve teamwork between coworkers. Statement of the Problem:

An opportunity existed to improve teamwork among nursing staff.

Methods:

A PCDAE method was used to identify areas for improvement and guided implementation of

teamwork interventions.


The department's shared governance council reviewed results of unit surveys encompassing

teamwork elements. A comprehensive action plan started with the council developing a generic

teamwork survey to solicit data from the unit's nursing staff. A “Helping Hands” initiative was

created to prompt staff to reach out to at least one coworker during a shift. Subsequently, a

mandatory video was produced and assigned to the unit's staff which highlighted perceptional

views and encouragement of communication. Lastly, during daily, pre-shift staff meetings,

education concerning teamwork expectations was shared. Subsequent surveys were later

administered and reviewed to evaluate effectiveness..

Outcomes:

A preliminary, unit-based survey revealed 64% of staff intentionally offered help to others three

or more times during the last worked shift, which increased to 75% following the initiative. An

organizational safety survey revealed that 90.7% of staff reported positive perceptions of

teamwork on the unit; results increased to 92.7%. Additionally, an initial 86.2% of coworkers

agreed that when busy, others help out. The subsequent survey reflected a marked increase to

92.6%. Lastly, the NDNQI survey identified a score below the national average regarding nursing

support and teamwork. Subsequent survey data also reflected improvement


Utilizing unit specific interventions that emphasize communication and support to one another

has potential to improve nursing department perceptions of teamwork. Continual education

and evaluation of teamwork is necessary to validate and sustain these findings.

Reducing Medication Security Events Through Interprofessional

Collaboration

Krista Morgan, MSN, RN-BC, Dara Dilger, MSN, RN, CCRN-K, CNRN, NE-BC,

Tyler Scott, PharmD, and Cathy Seuell, MSN, RN, CCRN

Deaconess Hospital, Inc.


Medication Security Events (MSEs) occur when controlled substances removed from an

automated medication dispensing cabinet (ADC) are not documented, returned to the

device, or wasted. MSEs create a potential for adverse events due to administration

errors. Overdue reminders were generated for scheduled meds, but not for PRN meds.

Other issues included missing medications and regulatory consequences.


An opportunity existed to reduce the number of MSEs. Methods:

A Lean Six Sigma improvement methodology was used to guide the project.


MSE data was collected over a one-month period, revealing 55 MSEs. An analysis of the data indicated the primary issue was related to PRN medications. An interprofessional team collaborated and developed a solution, which was a link between the ADC and electronic health record. Upon removal of a PRN medication, a due time populated on the medication administration record (MAR). If the medication was not administered, the MAR indicated an overdue medication to remind the RN the documentation process was not completed. This change was successfully piloted on two nursing units for one month. Thereafter, education on the process was provided to all inpatient units where the process was implemented. This change in workflow triggered the creation of a new report to detect diversion.

Outcomes:

MSEs were assessed for three months, pre- and post-implementation of the new process. Comparison of the pre-implementation MSEs (n=316 out of 115,552 total events) to the post-implementation MSEs (n=78 out of 161,592 total events) showed a statistically significant reduction by 81.5% (p<0.001).


Interprofessional teamwork and collaboration is key to successfully creating innovative solutions. A change in technology reduced MSEs, improved patient safety, and helped meet regulatory requirements.

Sleep Promotion in the Hospitalized Patient Marissa Brosmer, BSN, RN, CMSRN

Memorial Hospital and Healthcare Center


Sleep is essential to restore physiological functioning and mental health while

supporting recovery from illness and injury. Sleep deficit has been linked to obesity,

cardiovascular disease, delirium, and delayed healing. Sleep is a basic human need and

many hospitalized patients complain about their quality and amount of sleep.

Clinical Question:

In hospitalized patients, how can sleep promotion interventions affect a patient’s

physical and mental health recovery compared to the traditional nightly routine?

Search of Literature / Best Evidence:

54 articles were identified using CINAHL, MEDLINE, and Proquest. Search keywords

including sleep, sleep promotion, sleep during hospitalization, and sleep deficit. 10

articles were found that met inclusion criteria for research of sleep promotion in the

hospitalized patient.


Documented evidence supports the health benefits of sleep; however, sleep promotion

does not appear to be a high priority for most acute hospital settings. Literature

emphasizes adequate sleep being essential to support recovery from illness. Studies

highlighted that sleep disturbances can be influenced by personal and environmental

factors.


Assessment and documentation of patients sleep patterns and routines will be

proposed as an intervention upon admission on a pilot unit. Staff will receive education

on ways to promote sleep in the hospitalized patient by incorporating home sleep

routines and decreasing environmental disturbances. Patient education will occur upon

admission and reinforced every evening. Baseline data will be collected to determine

staff and patient perceptions regarding quality of sleep.


Data will be collected one and three months post implementation to evaluate patient

and staff perceptions regarding quality of sleep. The goal is to take a proactive approach

to target opportunities to provide optimal sleep. The pilot unit results will be reviewed

with the possibility of expanding house wide. Future research could examine diabetic

patients, pain assessment, and falls.

Tamper Evident Technology: A Collaborative Approach to IV Therapy in Patients

with History of IV Abuse

Toni Eastridge, BSN, RN-BC, Michelle Hawes, MSN, RN, CRNI, VA-BC, and Brandy

Nord, BSN, RN

Memorial Hospital and Health Care Center


IV drug abuse is an increasing public health concern. The current or recent use of IV drug use

should not preclude the use of long-term IV antibiotics in this patient population. Hospitals do

not have processes in place to address this growing concern.


There is an increased opportunity that exists to improve the safety of IV medication

administration in patient populations where IV drug abuse is a concern.

Methods:

A PDCAE methodology was used to identify barriers and risks of providing IV therapy to known

IV drug abusers within and outside of the hospital setting.


High risk patients in a Midwestern, rural health system were identified through patient

interview and communication from providers. Once the patients were identified, the vascular

access specialist (VAS) collaborated with key stakeholders to establish a care plan. An infusion

therapy contract was signed by the patient and the VAS. Tamper evident technology (TET) was

placed on the IV access with education to nursing staff. Patient visitors were identified as an

obstacle necessitating the need for the patient door to remain open, close proximity of patient

to nurse’s station and possibility of limiting/restricting visitors.

Outcomes:

With success of TET use in inpatient setting, TET was utilized in outpatient and long-term care

setting. Key stakeholders are developing a formal process to include a screening tool and

completely develop a formal policy.


Tamper Evident Technology is one method to reduce risk for patients, caregivers, and the

organization. The use of TET can provide an alternative to daily placement of peripheral IV

access for outpatient infusion and allow the most appropriate route of medication delivery.

The Effects and Outcomes of Low Fidelity Clinical Simulation for

Respiratory Therapy Students: Clinical Judgement, Critical Thinking,

and Perceptions

Wesley Phy, MEd, RRT

University of Southern Indiana Respiratory Therapy

Background / Significance of Problem: The field of respiratory therapy is a growing and demanding profession that requires a solid educational foundation that includes good critical thinking skills and the ability to quickly make correct decisions that can have a direct effect on patient care.

Research Question / Hypothesis: The aim of this study was to determine whether the use of low fidelity clinical simulation significantly improved critical thinking, clinical judgment, self-confidence, and perceptions in regards to patient care and interaction.

Research Method: The population for this study included 15 second year respiratory therapy students placed into two groups. Both groups were provided with duplicate information using a standard lecture format for group one and a computer based clinical simulation program for group two. This study incorporated a triangulation of three different data sources, which included a post-study quiz, post-study survey, and a group debriefing session to determine student perceptions and attitudes of using low fidelity clinical simulation as a teaching method.

Findings: The results of this study show positive increases in student critical thinking, clinical judgment, perceptions, and self-confidence using low fidelity clinical simulation as compared to using standard lecture as a method of teaching.

Discussion of Results: Both groups completed an eight question post study quiz intended to assist in measuring understanding, critical thinking, clinical judgment, and student perceptions. Comparison was made between groups one and two post lecture and simulation quiz scores. Analysis of both group post study quiz scores indicated that students’ critical thinking, clinical judgment, understating, and perceptions in group two were increased from those participating in group one.

Implications for Healthcare Professionals: The implications of this study concludes that healthcare professionals retain more information through low fidelity computer simulation in comparison to standard classroom lecture of the same content. This likewise increases greater understanding, critical thinking skills, and clinical judgement of critical information required to safely maintain and provide adequate patient healthcare.

Tobacco, Ecigs and Marijuana- Knowledge Attainment by Regional

Dental Health Professionals

Lorinda L. Coan, RDH, MS and Erin Reynolds, PhD, MPH



The negative effects of tobacco are well known. Evidence is suggesting similar ill-effects from e-

cigarette and marijuana. Of further interest is whether the use of e-cigarettes serve as gateway

mechanisms to cigarette/marijuana use in youth and adults.

Research Question / Hypothesis:

Investigators sought to understand what dental healthcare providers knew regarding the oral

health impact of these products.

Research Method:

A review of the literature was conducted to create a two-hour continuing education session for

dental health professionals. Standard dental textbooks and PubMed/Cochrane Collection

databases were used for information retrieval. Participants were surveyed pre and post

presentation to determine level of knowledge regarding patient use of e-cigarettes, tobacco and

marijuana, oral manifestations, and health risks. The Post-survey also included questions

regarding satisfaction with the CE presentation.

Findings:

Most participants were dental hygienists (72.3%) and general practice dentists (20.0%) having a

range in years of practice (average 17.5 years-(s.d. 11.9)). The post-surveys show that

participants gained knowledge in tobacco, E-cigs, and marijuana with the mean score on the

pre-test being 57.87% (s.d. 13.65), while the mean total score on the post-test was 87.37% (s.d.

14.76). While the post-test scores showed gain, gaps remained in regards to marijuana.

Discussion of Results:

The presentation was well received. While the post-test scores showed gain, gaps remained in

regards to marijuana. A pre-/post-test can be useful to those in educational settings to

evaluate the knowledge of the population they are educating and the areas that may need more

focus in future sessions.

Implications for Healthcare Professionals:

With new laws in many states affecting the ease of use for e-cigarettes and marijuana, health

care providers must be aware of oral implications of their use and recognize the health risks and

early manifestations of potential health problems. Similar to those found with traditional

tobacco use, dental providers should stay abreast of current literature related to tobacco and

marijuana use and participate to impact laws surrounding these public health issues.

Vegetarian / Vegan Diet in Prevention of Colorectal Cancer: Is There

Evidence-Based Support for Use in Practice?

Angela Zirkelbach, Allison Rodriguez, Kiara Thompson, Tiana Hoover, and

Julie McCullough, PhD, RD



Colorectal cancer is the second leading cause of cancer deaths in the United States. Due

to the influence diet has on gastrointestinal tract health, researchers are exploring

dietary factors that may contribute to or reduce the risk of colorectal cancer.

Vegetarianism is becoming more common and we see that vegetarians tend to live

longer lives than non-vegetarians. For these reasons it is important to explore whether

they is a link between meat consumption and colorectal cancer.

Clinical Question:

For adults (18 years and older), does following a vegetarian or vegan diet reduce the risk

of colorectal cancer compared to an omnivorous diet?


A literature review was completed using ProQuest, PubMed, MEDLINE and CINAHL

databases with articles published between years 1997-2017. These were chosen

because they offered more search results, were more organized and allowed for ease of

use. The search terms used included: colorectal cancer, colon cancer, vegetarian diet,

plant-based diet, vegan diet, omnivorous diet, cancer, adults, low-meat diet, high-meat

diet, older adults, and meat. Results included seventeen prospective cohort studies with

5 primary articles meeting criteria and abstracted.


There is evidence that red meat and processed meat are associated with colorectal.

Results are unclear for specific meats including fish, pork, and egg and dairy products


This analysis of cohort studies suggests support for limiting the use of processed and red

meat as well as consuming vegetarian diets to reduce the risk of colorectal cancer.

Evaluation of Evidenced-Based Practice:

Grade II: Fair—The evidence consists of results from studies of strong design answering

the question addressed, but there is uncertainty attached to the conclusion because of

research design flaws including clearly described intervening factors and adequacy of

sample size.

JURIED POSTER ABSTRACT PROGRAM - USIMiranda Wahnsiedler MSN, BS, AGCNS-BC. RNC-OB, and Linda Baxter,...

Documents

Transcript of JURIED POSTER ABSTRACT PROGRAM - USIMiranda Wahnsiedler MSN, BS, AGCNS-BC. RNC-OB, and Linda Baxter,...